Healthcare Provider Details

I. General information

NPI: 1356211122
Provider Name (Legal Business Name): ASPIRE PHYSICIAN ASSISTANT P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 LONG BEACH BLVD UNIT 4622
LONG BEACH CA
90807-3315
US

IV. Provider business mailing address

3711 LONG BEACH BLVD UNIT 4622
LONG BEACH CA
90807-3315
US

V. Phone/Fax

Practice location:
  • Phone: 213-642-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY ROGERS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 213-642-2400